[nurse2Bjrh]

i wish to thank all of you who responded to my question concerning foley catherization. they all were very informative and i will make use of your advice as i advance in the nursing field. yes, i am indeed afraid of causing more pain to my patients. i have read where foley catheter insertion is equated with nasogastric tube insertion, and IV setup as procedures which may be painful to patients. i have experienced IV setup probably 4-5 times, and while i will agree they are far from pleasant, i have experienced things far worse. i think my aversion to foley catheter insertion is derived from the fact that it is so "psychologically traumatic" for patients, thus creating an added "mind pain" to the procedure. if i am way off base here please let me know. i read on the internet of a survey of emergency room patients, asking them to rate typical ER procedures as to how painful and traumatic they were. foley catherization was rated the second most painful and traumatic of ER interventions, behind fracture reduction. is there any reason that this procedure would be more painful when done in the emergency room? no mention is made of any other area of the hospital, i presume because the way the survey was worded. again, thank you. it is great to have the opportunity to bring what must be very minor, even trivial, problems we have, with the knowledge that all who respond have, "been there, done that, felt that". it is reassuring to me to realize that my problems are not just mine, but were faced by virtually all nurses.

[AmandaWIRN]

I wouldn't say that catheterization is more painful in the ER- it's probably that most patients are awake in the ER when they have a foley placed, as opposed to pre-op, where they may be under general anesthesia. I have never had a foley or NG, but from what my patients have told me, NG insertion is far more painful & traumatic than a foley placement.

[Diver98]

Having had all three, I can state from personal experience that NG tube insertion done as most Nursing Schools teach it, is barbaric. I had a wise ER MD show me the best way to anesthetize my patient's nasal, oral passages prior to insertion. 10 ml of nebulized 1% lidocaine mixed with 3 ml of NS. The patient had a hx of GI Bleeding, so you would assume that he was used to it. No, He started crying afterward, and grabbed my hand and thanked me profusely for being sooooooo gentle.As for the foley and fracture reduction, with the advent of moderate or concious sedation there is NO reason when properly used and administered that a patient should be having pain. I say that with the proviso, that nurses have to be advocates for their patients, If you think the patient isn't sedated enough or deep enough TELL the doctor to WAIT. Has your patient had enough meds?, Why do I know? ,A motorcycle accident, open fracture rt forearm, (the O.R. got that one, and a dislocated rt hip, E.R. got that one), Just enough Fentanyl, and Propofol, and it was a breeze, but the tubes went in before all, not a drop of lidocaine:firedup:

[nurse2Bjrh]

thank you for your reply. in your opinion, as far as foley catherizations are concerned, is there any difference between being catherized as an inpatient already in the hospital, and in the emergency room? when a patient in the hospital is catherized in conjunction with a procedure for which they will be anesthesized, one would expect that the insertion of the foley would occur after the patient is under. my question dealt with the other occasions when a catherization was ordered for patients, say in the emergency room, in which the patient was to be catherized and this was not prior to a planned procedure. as an example, patient taken to the ER, and after examination had taken place, the physician knew that the patient's condition would necessitate a foley. would the patient then be sedated for the insertion of the catheter? thank you very much.

[AmandaWIRN]

When catheterization is included as part of a planned procedure, then when at all possible, the foley will be inserted after anesthesia has taken effect. When it is unplanned, like in the emergency room, then, as I have said before, sedation will most likely not be ordered just for the insertion of a foley. People are sedated in the ER for other things (like reduction of dislocated joints, as the previous poster mentioned), but I have never heard of anyone being put under sedation only for foley insertion.

[RNinVT]

I've had patients who were worried at first, only to tell me after that it wasn't as painful as they thought it would be. I imagine its not a comfortable thought to know a tube will be put up your urethra. Unfortunately, its one of those situations where most other options have been explored. Someone that can not urinate by themselves will most likely be in extreme pain unless a foley is inserted. The trick is to lubricate, educate, and be gentle with your patient. I am a new nurse, and I myself hate causing my patients pain. However, like a needle with medication sometimes has to be given, sometimes a little pain is required to make someone feel better in the long run.

[cassioo]

well said sometimes you gotta do what you gotta do.